In this article we take a brief look at over the counter oral contraception; a physiotherapist that crossed professional boundaries; and the organ donor system in New Zealand.

Medsafe considers over the counter oral contraception

The oral contraceptive pill may soon be available over the counter at pharmacies, without a prescription from a general practitioner.

Green Cross Health and Pharma Projects have submitted a proposal to Medsafe regarding the re-classification of selected oral contraceptives. They argue that oral contraceptives are one of the most used, most studied, and most effective medicines in use. There is also little potential for misuse, a low risk of overdosing, and straightforward dosage.

Women can already obtain the emergency contraceptive pill directly from pharmacists. The proposal argues that there is an ‘unmet demand’ for the pill which has resulted in rising demand for the emergency contraceptive pill, and a greater number of unwanted pregnancies. Currently women must visit their GP and get a prescription for the pill which can be given for a maximum of 180 days (six months).

Pharmacists would be required to complete an approved training course, and comply with strict guidelines when issuing the pill. A face-to-face consultation would include blood pressure monitoring, side effect advice, and GP referral if necessary.

A similar system is already in place in the United States and Australia. International surveys suggest women prefer to visit a pharmacy to pick up the pill rather than visiting their GP. A 2012 Green Cross Health national survey also showed that women wanted non-prescription access to the pill.

However, the Royal New Zealand College of General Practitioners is opposing the proposal on the basis that although prescriptions for the pill may look easy, they require medical judgment. While the pill is safe for most women, for a small group it could pose serious health risks, leading to blood clots, liver problems and even strokes. GPs also consider prescribing the pill is an important way to check up on a patient’s overall health and provide sex education.

Medsafe’s medicines classification committee is currently considering the proposal.

In a decision which demonstrates the importance of health professionals maintaining professional boundaries, the HDC has declared a physiotherapist’s intimacy with a patient in breach of the Code of Health and Disability Services Consumers’ Rights.

The physiotherapist (Mr C) and patient (Ms B) were family acquaintances. They attended the same church and Ms B attended Mr C’s fitness classes twice a week. Ms B sustained a shoulder injury and visited Mr C’s clinic nine times over a five week period, often with her children.

Mrs B said that during the physiotherapy sessions they would each talk about their personal concerns. If Ms B missed a fitness class, Mr C would contact her to ask if she was okay. Even before treating her, Mr C would pull her aside during class and ask her how she was and she responded by sharing a number of personal matters.

On the day of Ms B’s last appointment with Mr C, a number of text messages were exchanged between them. As a result of these Mr C visited Ms B’s house to drop off dvds. Though the circumstances relayed by Mr C and Ms B differed, both agreed that Mr C stayed to watch a movie, eat pizza, and that they had sex several times that night before Mr C left in the morning.

Following that encounter Ms B made it clear she did not want a relationship. Mr C believed they had a ‘connection’ and made numerous attempts to contact her. Eventually Ms B’s father laid a complaint with the HDC.

The HDC held Mr C had breached right 4(2) of the Code by failing to maintain a professional standard of care by:

having sex with the patient the same night as their final appointment;

discussing his personal circumstances during physiotherapy appointments; and

communicating with the patient by mobile phone outside of the professional relationship.

This case has been referred to the Director of Proceedings to determine whether any further proceedings should be taken. The HDC also recommended that Mr C provide a letter of apology to Ms B and undertake further education and training on ethics and professional boundaries.

Organ donor system in New Zealand could be unethical

The National Ethics Advisory Committee has raised concerns about the organ donor system in New Zealand. The Committee considers that the current system is ethically questionable, and may lead to waiting listed patients receiving ‘false hope’.

In its report the Committee identified several areas as particularly concerning:

Equity of access – the Committee considered that some people were being treated differently in the referral and assessment processes, when receiving an organ transplant, or in being placed on the deceased donor waiting list. Some of the differences depended on the organ involved. However, the Committee was also concerned that Maori and Pacific people were less likely to receive a transplant than New Zealand European individuals.

The listing process – Whether a person is placed on a list for a transplant is currently determined by the likely outcome, need, and equity. The Committee considered that it was not clear how these competing principles were weighed against each other. It also identified concerns with age-based prioritising, and the process for determining survival probabilities.

The donor list for kidney transplants – Currently there are more people on the deceased donor waiting lists than available organs, meaning some people will never get an organ. In particular, there is no attempt to match the number of people seeking a kidney transplant with available kidneys, presumably because patients can remain on dialysis while they wait. However, the Committee considers that some of these waitlisted patients have very low chances of receiving transplants, despite living in ‘false hope’ that a transplant may eventuate.

The Committee’s report recommends a thorough review of the ethics of the organ donor system in New Zealand, and highlights the need for thorough consultation with patients, the health sector, and stakeholders on this issue. Associate Health Minister Peter Dunne has ordered a review in response to the report.